SUMMER
2016
the mix A Blend of T ips So You Can Be Your Best
Learn the facts about COPD Meet a fellow member Get tips for handling asthma and diabetes
Stir in Some Healthcare Tips The Mix, our newsletter for Health Alliance Connect Medicaid members, reminds you it’s always a great time to connect to the care you need and use your benefits to their fullest.
Kick off your summer with this Mix: Ways to cope with COPD
A story of a fellow member’s battle with diabetes
Tips to help control asthma
Steps to help keep diabetes in check 1
Mix in Health Health Alliance Connect helps make sure you get the care you need from start to finish. That means you’ll have a primary care physician (main doctor, also called PCP) who focuses on all your health needs. And you might be eligible for other services and support to help you meet your goals. Plus, all your health records stay in one place.
Havea aQuestion? Question?Call Us. Have • ICP-Medicaid: 1-877-933-8480, Monday Have a Question? Callthrough Us.Friday • Hours: Monday through Friday, 8 a.m. to 8 p.m. from 8:30 a.m. to 5 p.m. • Hours: Monday through Friday, 8 a.m. to 8 p.m. • ICP-Medicaid: 1-877-933-8480 • ICP-Medicaid: 1-877-933-8480 • TTY users call 711 • MMAI-Medicaid and Medicare (Duals): 1-866-951-0264 • MMAI-Medicaid and Medicare (Duals): 1-866-951-0264 • HealthAllianceConnect.org • Both: TTY users call 711 or 1-800-526-0844 (Illinois Relay). • Both: TTY users call 711 or 1-800-526-0844 (Illinois Relay).
Take Charge of Your COPD Chronic obstructive pulmonary disease (COPD) is a lung disease that makes it hard to breathe. It cuts the amount of air that goes in and out of the lungs, which can cause shortness of breath, coughing and wheezing. COPD is sometimes called emphysema or chronic bronchitis. It can be confused with asthma, but COPD is treated differently than asthma.
Avoid triggers.
A trigger is anything that makes your COPD worse. Some common ones are smoke, car exhaust, stress or anxiety, certain foods, strong smells and major changes in weather.
Stop smoking.
One of the best things you can do for your health is to quit smoking. For help quitting, call the American Lung Association’s Tobacco QuitLine at 1-800-LUNGUSA (1-800-548-8252) or visit lung.org.
If you have questions about your COPD, call 1-877-933-8480 (TTY 711).
Keep track of your breathing.
If you notice a change in your breathing or are having trouble catching your breath, call your doctor. Take action early. Don’t wait until your symptoms become an emergency.
Take your medications as prescribed.
Talk to your doctor about meds that might help you control your COPD. You might take some on a regular basis and others as needed. Don’t stop taking your meds on your own, even if you feel like your symptoms are under control. Talk to your doctor if
you have questions about your med routine.
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Member Stays Positive while Struggling with Diabetes Mary Moore, a Connect member from Champaign, grew up knowing about diabetes. Her mother was diagnosed with type 2 diabetes when Mary was around 12 years old. She watched her mom get sick and have to be on insulin. Years later, doctors diagnosed her father with the same disease. And because family history plays a big part in type 2 diabetes, Mary was also at risk. Mary had gestational diabetes during her last pregnancy. Gestational diabetes is a type of high blood sugar that can affect a woman’s pregnancy and her baby, and it’s also a risk factor for type 2. Two years after her gestational diabetes scare, the mother of four got the same diagnosis as both her parents and started her own battle with type 2 diabetes. After decades of dealing with her disease, Mary now turns to Health Alliance Connect for help. She says she is thankful for the free rides program when she doesn’t have another way to get to her doctor visits. She also values the relationship she has with her case manager, Cindy. Mary says Cindy calls to check how she’s doing with her diabetes and is great about following up.
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Havea aQuestion? Question?Call Us. Have • ICP-Medicaid: 1-877-933-8480, Monday Have a Question? Callthrough Us.Friday • Hours: Monday through Friday, 8 a.m. to 8 p.m. from 8:30 a.m. to 5 p.m. • Hours: Monday through Friday, 8 a.m. to 8 p.m. • ICP-Medicaid: 1-877-933-8480 • ICP-Medicaid: 1-877-933-8480 • TTY users call 711 • MMAI-Medicaid and Medicare (Duals): 1-866-951-0264 • MMAI-Medicaid and Medicare (Duals): 1-866-951-0264 • HealthAllianceConnect.org • Both: TTY users call 711 or 1-800-526-0844 (Illinois Relay). • Both: TTY users call 711 or 1-800-526-0844 (Illinois Relay).
When I’m stressed and need to get away, I can come to the library and just relax.
Although Mary now has to check her blood sugar, watch what she’s eating more closely and keep track of her medicine, she still finds joy in the little things. Around the time her mom was diagnosed with diabetes, Mary started writing poetry and still does today in her spare time. She also enjoys going to the library to free her mind from worry and read mystery novels. “It’s a relaxing atmosphere,” she says of the library. “When I’m stressed and need to get away, I can come to the library and just relax.” Along with reading and writing, she likes to relax with a bingo card in hand. To her, bingo is a chance to spend time with people she loves. She began playing with her mother and now plays alongside her oldest daughter, keeping up a family tradition.
Family is important to Mary. She is a foster care provider and also enjoys having her grandkids around. Along with bingo tips and diabetes knowledge, she hopes to teach her children and their kids about life by sharing the wisdom she’s gained along the way.
I take what I have learned when I was younger and try to help them maneuver through life a little easier. 4
Keep Up on Diabetes Testing
The American Diabetes Association recommends getting the services below each year. Call your doctor to see which ones you still need to get this year.
• A1C test—two to four times a year with a goal of less than 7 percent • Blood pressure check—at each doctor visit with a goal of less than 140/90 • Retinal eye exam—once a year • Urine test for protein—once a year • Foot exam—once a year (more often if you have foot problems) • Flu shot—once a year
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Controlling your diabetes is about more than just your blood sugar level. Diabetes can affect your health in other ways, so you need certain tests and exams to make sure you are as healthy as possible.
Havea aQuestion? Question?Call Us. Have • ICP-Medicaid: 1-877-933-8480, Monday Have a Question? Callthrough Us.Friday • Hours: Monday through Friday, 8 a.m. to 8 p.m. from 8:30 a.m. to 5 p.m. • Hours: Monday through Friday, 8 a.m. to 8 p.m. • ICP-Medicaid: 1-877-933-8480 • ICP-Medicaid: 1-877-933-8480 • TTY users call 711 • MMAI-Medicaid and Medicare (Duals): 1-866-951-0264 • MMAI-Medicaid and Medicare (Duals): 1-866-951-0264 • HealthAllianceConnect.org • Both: TTY users call 711 or 1-800-526-0844 (Illinois Relay). • Both: TTY users call 711 or 1-800-526-0844 (Illinois Relay).
Stay on Top of Your Asthma Asthma doesn’t have to hold you back. Even though there isn’t a cure, there are things you can do to control it. Health Alliance Connect can help you get the treatment and medicine you need to stay out of the emergency room and keep doing the things you want to do. It’s important to see one doctor for your asthma so he or she can get to know your asthma and your needs. Go in for an asthma checkup at least every six months. Here are some things to talk about with your doctor. • If you have been to the emergency room for your asthma • If you feel like you are having more symptoms (tell him or her as early as possible) • If you’ve missed work or school because of asthma • If you are using quick relief meds (inhaler or nebulizer) more than three or four times a day • If you aren’t taking your meds as prescribed and why (cost, side effects, etc.)
A Health Alliance Connect case manager can also help you stay on top of your asthma. He or she can go over your treatment plan with you, try to help you get meds if you can’t afford them and answer your asthma questions. If you are interested in working with a case manager or have questions about your asthma, call 1-877-933-8480 (TTY 711). 6
Essentials What you’re about to read on the next few pages, a piece we call Essentials, is a tool we send you once a year. It explains: • How to find answers online and get help in another language • Quality improvement and health and wellness info • Your rights and responsibilities as a member • Other need-to-know info Check it out, and if you have any questions, call the number on the back of your ID card.
Member Services Is Here to Help 1-877-933-8480, TTY 711, Monday through Friday 8:30 a.m. to 5 p.m. CT. We can help you with questions about claims, coverage, appeals, pharmacy issues, preauthorization, utilization management and information about the doctors, clinics and hospitals we work with. We can also give you printed versions of any of the information on our website. After normal business hours, leave a message, and your call will be returned the next business day. Please note that all non-urgent review requests received after normal business hours will be recorded as being received the next business day.
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Find Answers Online
Find answers to your questions online anytime at HealthAlliance.org. It has information about your coverage and our processes, such as: • Our most recent HEDIS® and CAHPS® scores • Medical and pharmaceutical management policies and procedures, including how we review new technology • How to file a complaint or appeal, including your right to involve an external review organization • Which benefits and services are included and excluded from your coverage in and out of the service area
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
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How to get emergency care, primary care, specialty care and behavioral health services during and after normal business hours in and out of service area
• How to get information about in-network physicians and hospitals
Register* and log in at YourHealthAlliance.org today to: • Learn how to submit a claim • Check the status of a claim • View the Drug Formulary, evaluate drug interactions and determine financial responsibility for prescriptions • View your deductible and find your copayments or coinsurance • Read the Health Alliance notices of privacy practices Visit HealthAlliance.org, or sign up for a username and password by going to YourHealthAlliance.org and registering as a member. *If you don’t have Internet access, you can get printed copies of the materials on the Health Alliance website by calling Member Services.
We Speak Your Language If you are more comfortable speaking a language other than English, try our telephone translation service, Language Line. We provide access to interpreters who speak 200 different languages. Simply call the Member Services number listed on the back of your member ID card and tell them which language you speak.
Si usted necesita un interprete para traducir esta información, por favor llamar al teléfono gratis 1-877-933-8480 y pregunte por la “Language Line.” Si usted necesita documentos tradujeron a un idioma diferente, usted puede solicitar que llamando 1-877-933-8480.
Better Service, Better Care To view our Quality Improvement program, go to HealthAlliance.org, open the More menu and choose “Our Numbers” under Education.
Health and Wellness Health Alliance offers disease management programs for members with asthma, diabetes and high blood pressure. The case management program serves members who need help managing a chronic or complicated health condition or navigating the healthcare system. For more information or to enroll in any of these programs, members or their caregivers may call 1-800-851-3379, extension 8112.
Pharmacy Benefits and Management Procedures The Health Alliance Drug Formulary lists the preferred and most-used brand-name drugs. It also has information on other pharmacy management procedures and processes, such as generic substitution, step therapy, preauthorization, managed dose limits and other limits or quotas.
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To view the Drug Formulary online, log in at YourHealthAlliance.org. Choose “Prescription Drug Benefits” from the Your Benefits section, and then click the Your Drug Benefits button. You may request a paper copy of the Drug Formulary or any other pharmacy materials on the website by calling the Health Alliance Pharmacy Department at 1-800-851-3379, option 4. Physicians may request a Medical Exception for a medication on behalf of a member or request more information by calling the Health Alliance Pharmacy Department at 1-800-851-3379, option 4. Specific information required from the provider is detailed in our online Drug Formulary. The Medical Exception decision may be appealed by calling Health Alliance Pharmacy at 1-800-851-3379, option 4.
Know Your Rights and Responsibilities
• Participate with providers in making decisions about your health care. • Receive treatment options and alternatives presented in a manner appropriate to your condition and ability to understand. • Refuse treatment to the extent of the law and to be told of the outcome. • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation. • Voice concerns, complaints or appeals about the organization and the care it provides and to receive prompt answers. • Formulate advance directives. •
Appeal to or file directly with the Department of Health and Human Services (HHS) Office of Civil Rights (OCR) any complaint of discrimination, on the basis of race, color, national origin, age, or disability in the receipt of health care services.
• Exercise your rights without retaliation.
You have the right to: • Receive all services that Health Alliance is required to provide per our agreement with Illinois Healthcare and Family Services.
• Receive a copy of your medical records and request the records be amended or corrected. • Not be balanced billed.
• Be treated with respect and with due consideration for your dignity and privacy.
• Reasonable accommodations.
• Receive information about the organization, its services, its practitioners, and provider and member rights and responsibilities.
You have a responsibility to:
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• Supply information (to the extent possible) that the organization and its practitioners and providers need in order to provide care.
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Receive information including enrollment notices, informational and instructional materials in a manner that may be easily understood.
• Treat your PCP and office staff with courtesy and respect.
• Follow plans and instructions for care that you have agreed to with your practitioners and providers.
• Understand your health problems and participate in developing mutually agreed upon treatment goals, to the degree possible. • Decide about having medical treatment or procedure before it begins. • Help your PCP obtain your medical records. • Not seek care from a specialist, unless referred by your PCP. • Not seek care in an emergency room for conditions that are not life-threatening without contacting your PCP. • Keep all scheduled appointments and be on time. • Follow the rules and regulations of Health Alliance.
Health Alliance Ensures Reasonable Access to Services Health Alliance employees never encourage decisions that result in underutilization of care. We do not give financial inducements or set quotas for issuing denials of coverage or care; nor do we keep statistics identifying individual providers and their denial rates. Coverage decisions made by our medical directors, nurse coordinators, pharmacy coordinators and pharmacists are based only on appropriateness of care and service and the existence of coverage. There are no incentives, financial or otherwise, to encourage barriers to care and services.
Switching from Pediatric to Adult Care If you’re ready to switch from pediatric (child) to adult health care or have a child who is ready, there are lots of options. Pediatricians typically see children from birth to age 18, but you can stay with your pediatrician if the relationship works. You can choose a primary care physician (PCP) who works in family practice, general practice or internal medicine. To change your PCP or get a list of in-network doctors, call Member Services at 1-877-933-8480 or log in at YourHealthAlliance.org.
We Respect Your Privacy To see our website privacy policy or our notice of privacy practices, please call Member Services. This information is also available on any of our websites at the bottom of the page.
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301 S. Vine St. Urbana, IL 61801
2016
EV ENT
CALENDAR For more community events, visit our website, HealthAllianceConnect.org.
Give a Gold Star Have you had a great experience with somebody at Health Alliance Connect? If so, you can give that person a Gold Star as a special way to say thanks. We’ll share your story with that person and his or her manager and peers. You can thank someone today at HealthAlliance.org/GoldStar.
Central Illinois Agency on Aging Celebrating Generations Expo Embassy Suites Conference Center 100 Conference Center Dr. | East Peoria, IL June 1, 2016 | 10 a.m.–2 p.m. Low Vision Technology Fair South Side Christian Church 2600 S. MacArthur Blvd. | Springfield, IL June 2, 2016 | 10 a.m.–2 p.m. Senior Care Network Picnic in the Park Fon du Lac Park District 201 Veterans Dr. | East Peoria, IL June 3, 2016 | 11 a.m.–2 p.m. Boone County Council on Aging Healthy Living Expo Belvidere North High School 9393 Beloit Rd. | Belvidere, IL June 7, 2016 | 9 a.m.–1 p.m. Healthy Food Kiosk Party CRIS Healthy Aging Center 309 N. Franklin St. | Danville, IL June 8, 2016 | 10 a.m. - 1 p.m. 2016 McLean County Senior Expo Illinois State University Bone Student Center 100 N. University St. | Normal, IL August 2, 2016 | 9 a.m–2 p.m.
Don’t forget to stay in touch! Just like your friends and family, we need to know if you move or get a new phone number. That way, we can keep in touch, send you important info about your plan and make sure you get your copy of The Mix. You can also connect with us on social media. We’ll keep you in the loop on news and events, plus give you healthy living tips and info. Facebook.com/HealthAlliance
Twitter: @Health_Alliance
Pinterest.com/HealthAlliance
Please call ICP-Medicaid: 1-877-933-8480 to tell us what changed (TTY users call 711). Or send an email with your name, member number, address and phone number to connect@healthalliance.org. caid-SPDmix-0516